Respiratory Support of Pregnant Women with COVID-19 Including Fetal Assessment Recommendations
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Describe the different types of oxygen delivery methods 2. Discuss the fetal monitoring considerations for pregnant patients with respiratory failure due to COVID-19
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from through , participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0,2 contact hours.
Although overall respiratory management is similar for pregnant women with COVID-19 compared to the general population, there are certain issues that are unique to this group. In addition, fetal wellbeing needs to be taken into consideration. This expert review by Pacheco et al. (Green Journal, 2020) provides key management points for treating patients with COVID-19 related respiratory compromise during pregnancy.
Pregnant Patient with Confirmed or Suspected COVID-19 and SpO2 <94%
Conventional O2 therapy*: Target range 94% to 96%
Consider self-awake prone position
Ensure airway expert is aware of patient
If patient not improving using conventional oxygen delivery methods
Reduce flow 5 to 10 L/min every 4 to 6 hours when an FiO2 of 0.4 to 0.5 is reached
Target SpO2 level >94%
If patient still does not improve
Consider intubation and invasive mechanical ventilation
*Conventional Oxygen Delivery Methods
Conventional Nasal Cannula
O2 flow: 1 to 6 L/min
O2 concentration: 24% to 40%
Conventional face mask
O2 flow: Set between 5 and 10 L/min
O2 concentration: Typically 40%
Same as conventional face mask, but operator has more control over FiO2
Partial rebreather mask
Set O2 flow ≥10 L/min
O2 concentration: 60% to 70%
Set O2 flow ≥10 L/min
O2 concentration: 80%
**Requirements for high-flow nasal cannula
Ensure patient is
Hemodynamically stable with normal mental status
Can protect her own airway: Clear own secretions and good cough reflex
Fetal Assessment for Patients with COVID-19 Respiratory Failure
<23 to 24 weeks
Fetal monitoring is not recommended
Stable and on conventional oxygen delivery system or high-flow nasal cannula
>24 weeks: Daily NST
Mechanical ventilatory support
24 to 28 weeks: Individualize based on multiple clinical factors including EFW, NICU support, maternal body habitus and availability of PPE
>28 weeks: Continuous monitoring
If patient’s respiratory status is deteriorating
Especially >28 weeks, the authors recommend
…proceeding with a controlled delivery (likely cesarean) instead of awaiting fetal distress from refractory hypoxemia and needing an emergent delivery in the intensive care unit
Note: Authors caution that it is still important to weigh risks and benefits of fetal monitoring due to the significant risks associated with emergency cesarean delivery in patients with impaired respiratory function | Delivery “does not improve respiratory status of patients with acute respiratory failure” although authors acknowledge that this statement is based on limited evidence
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
NOT ENOUGH CME HOURS
It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan